Pre-Screening Application

Date*

Prospect's Name*

First Middle Last

Date of Birth*

SWIC ID#

Primary Phone*

Secondary Phone

Email*

Address*

Street Address City ZIP / Postal Code

Sex*

Female
Male
Non-Binary
Prefer not to answer

Gender*

he/him/his
she/her/hers
they/their/theirs

Race*

Native American/Alaskan Native
Asian
Black/African-American
Hawaiian/Pacific Islander
Hispanic
White
Prefer not to answer

Military Status*

None
Active
Recently Separated Veteran
Retired Veteran
Disabled Veteran
War/Combat Veteran
Dishonorable Discharge

Marital Status*

Single
Married
Divorced
Other

Are you interested in a career in the construction industry?*

Yes
No

Do you have the ability to attend a 10 week training program?*

Yes
No

Do you have a high school diploma or equivalency (GED)?*

Yes
No

What is your highest level of education?*

Do you have 1 year of high school level Algebra 1 or equivalent with a grade of "C" or better?*

Yes
No

Are you able to participate and understand classroom instruction given in the English language?*

Yes
No

Have you participated in a pre-apprenticeship training before?*

Yes
No

Are you 18 years of age or older?*

Yes
No

Are you an Illinois resident?*

Yes
No

Are you authorized to work in the United States?*

Yes
No

Do you have a valid drivers license?*

Yes
No

Do you have restrictions preventing you from getting a valid drivers license?*

Yes
No

How will you get to a worksite/training?*

Own Car
Get a Ride
Bus
Train/Subway
No Reliable Transportation
Other

Some employers will complete a background check for new employees. Please check all the following that applies to your situation:*

I am registered in the sex offender registry.
I have a violent felony conviction.
I have a nonviolent felony conviction.
I have a misdemeanor conviction (excluding traffic violations) within the past 7 years.
I have been on probation in the last 10 years (excluding traffic violations).
None of the above applies to me.

Some employers will require you to be drug free for some apprenticeships. In those cases they will require you to pass a drug test showing no substances in your system for the previous 30 to 120 days. Will you be able to pass a drug test?*

Yes, I am drug free and can pass a drug test.
Yes, I have been drug free for at least 30 days.
Yes, I am willing to make changes to pass a drug test.
Yes, I want to be able to pass a drug test, but I need help
I am not interested in careers that require a drug test.

Are you willing to take a drug test?*

Yes
No

Have you worked in construction before?*

Yes
No

What is your current employment status?*

I have not worked before, this is my first job.
I am employed and currently working.
I am employed but have received a notification of termination/layoff.
I am unemployed and have been actively looking for work
I am unemployed but have not been actively looking for work.

Who is your most recent employer?

Employer Name:*

Start Date*

End Date (if applicable)

Job Title*

Employer Full Address*

Street Address City State ZIP Code

Job Duties*

Hours worked per week*

Are you currently employed here?*

Yes
No

Does this job meet your needs?*

Yes
No

Why or why not?*

Reason for leaving?*

Was this your primary employment?*

Yes
No

Were you self-employed?*

Yes
No

How did you hear about this program?*

CAPTCHA

Pre-Screening Application

Who is your most recent employer?

East St
Louis

Fire
Science

PSOP
Campus

Scott Air
Force Base

SW Justice &
Workforce Dev

Other
Campus